National Women's Health Week: How Menopause Changes Sleep

Last updated: October 2026

Sleep disturbance becomes more common through the menopausal transition: a meta-analysis of 24 studies covering 63,542 midlife women found higher odds of sleep disturbance during perimenopause and after menopause than before it (Xu & Lang, 2014). In a long-term study of 3,045 women, trouble falling asleep and staying asleep rose through the transition, and more frequent hot flashes went with more sleep problems (Kravitz et al., 2008). Below is what that research shows, how night waking tends to change after menopause, and the separate question of what the pillow does to the neck overnight.

Key takeaways

A meta-analysis of 24 studies covering 63,542 midlife women found higher odds of sleep disturbance in perimenopause and after menopause (Xu & Lang, 2014).
In 3,045 women followed through the transition, more frequent hot flashes went with more trouble falling and staying asleep (Kravitz et al., 2008).
A Pillowise fitting takes three measurements (shoulder width, neck circumference and neck length) and adds sleeping position and bed type to choose from seven sizes.

How does menopause change sleep?

A systematic review and meta-analysis pooled 24 studies covering 63,542 midlife women. Compared with women before menopause, those in perimenopause, after natural menopause, and after surgical menopause had higher odds of sleep disturbance, and the link held after adjusting for age and other factors (Xu & Lang, 2014).

The authors described the effect as small. It also varied by ethnicity, which is one reason two women going through the same stage can describe very different nights.

What did a long-term study of women find?

The Study of Women's Health Across the Nation followed 3,045 women aged 42 to 52 from five racial and ethnic groups, with yearly assessments over seven years (Kravitz et al., 2008).

The odds of trouble falling asleep and trouble staying asleep rose as women moved through the transition. Women with more frequent hot flashes had higher odds of all three sleep problems the study tracked: falling asleep, staying asleep, and waking too early.

Sleep was self-reported, and the study shows association rather than cause.

Does night waking settle after menopause?

For many women it stays about where it was. A later analysis of 1,285 women in the same study tracked waking several times a night across the years around the final menstrual period (Kravitz et al., 2017).

Four patterns emerged: low waking (37.9 percent), moderate (28.4 percent), increasing (15.3 percent), and high (18.4 percent). Trouble falling asleep, early waking, and frequent hot flashes were linked to waking problems that persisted after menopause.

What does pillow height change overnight?

Sleep disturbance and neck comfort are separate questions, and the pillow belongs to the second one. In a radiographic study of 16 adults, raising the pillow from 0 to 10 to 20 cm increased T1 slope and C2-7 Cobb angle while neck tilt decreased (Kim et al., 2015).

In a pilot EMG study of 15 adults lying on their side, the height matched to shoulder width produced the lowest neck and shoulder muscle activity (Jiao et al., 2025).

Why do generic pillows miss?

A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009). No single optimal pillow height can be specified, because it depends on four variables that differ from person to person: cervical alignment, body dimension, contact pressure, and muscle activity (Lei et al., 2021).

What we measure

Pillowise is a fitted cervical pillow that licensed healthcare providers measure and dispense, made in seven sizes.

Our sleep specialists take three measurements: shoulder width, neck circumference, and neck length. Combined with sleeping position and bed type, an algorithm identifies the best-fitting pillow from seven sizes.

Shoulder width is the measurement the EMG study found mattered most. A height matched to it produced the lowest neck and shoulder muscle activity during side sleeping (Jiao et al., 2025), and body dimension is what drives the individual optimum (Tian et al., 2025).

A systematic review of 11 studies covering 309 participants identified a 7 to 11 cm unloaded central height among the parameters supporting spinal alignment and sleep comfort (Radwan et al., 2021). The size is chosen from those three measurements plus sleeping position and bed type, rather than from a single stock height.

Pillowise pillows are made from premium Dutch memory foam and certified to OEKO-TEX Standard 100, meaning every component has been tested against the standard's limits for harmful substances.

Scope

The menopause studies measured self-reported sleep, not pillows. No study has tested whether a pillow changes sleep during the menopausal transition, and we make no such claim. The pillow studies are small, and the most recent systematic review found no clear advantage for any pillow type in chronic neck pain (Ghosh et al., 2025).

For providers

National Women's Health Week falls in mid-May. Midlife patients often mention poor sleep in passing, and asking directly how they are sleeping brings it into the visit.

Hot flashes and persistent sleep disturbance belong with the patient's physician or women's health clinician. Neck comfort at night is the part your visit can address directly.

A fitted pillow extends the work of the visit into the hours between visits, alongside the exercise, manual therapy, and other care the provider is already delivering.

Common questions

Is poor sleep during menopause common?

Sleep disturbance is more common during and after the transition. A meta-analysis of 24 studies covering 63,542 women found higher odds in perimenopause and after menopause than before it, though the effect was small (Xu & Lang, 2014).

Do hot flashes affect sleep?

They are linked. In 3,045 women followed through the transition, more frequent hot flashes went with higher odds of trouble falling asleep, staying asleep, and waking early (Kravitz et al., 2008). Treatment options are a conversation for the patient's physician.

Can a pillow help with menopause sleep problems?

No study has tested that, and we make no such claim. What pillow height changes is neck alignment and neck muscle activity during sleep (Kim et al., 2015; Jiao et al., 2025).

Is a contoured pillow from a store enough?

Not reliably. A standard contoured pillow, not fitted to the individual, performed no better than ordinary shapes in a randomized study of 106 side sleepers (Gordon et al., 2009), and no single optimal height can be specified because it depends on four variables that differ from person to person (Lei et al., 2021). A contour helps only if its height matches the person using it. That is what the fitting settles, in a provider's office.

Find a Pillowise provider or become one

Pillowise pillows are clinically measured and dispensed exclusively through licensed healthcare providers as part of broader sleep, posture, and recovery education.

To locate a Pillowise provider near you, visit: Find a Reseller

Licensed healthcare providers interested in offering Pillowise may register here: Become a Reseller

References

Ghosh, S. K., Goyal, M., & Goyal, K. S. (2025). Effect of pillow on pain, disability and sleep quality in patients with chronic neck pain: A systematic review. Rehabilitación, 59(3), 100922. https://doi.org/10.1016/j.rh.2025.100922

Gordon, S. J., Grimmer-Somers, K., & Trott, P. (2009). Pillow use: The behaviour of cervical pain, sleep quality and pillow comfort in side sleepers. Manual Therapy, 14(6), 671-678. https://doi.org/10.1016/j.math.2009.02.006

Jiao, R., Xiao, W., Wang, M., Yu, S., & Li, H. (2025). The impact of pillow height on neck muscle activity: A pilot study. Sleep and Breathing, 29(1), 40. https://doi.org/10.1007/s11325-024-03219-6

Kim, H. C., Jun, H. S., Kim, J. H., Ahn, J. H., Chang, I. B., Song, J. H., & Oh, J. K. (2015). The effect of different pillow heights on the parameters of cervicothoracic spine segments. Korean Journal of Spine, 12(3), 135-138. https://doi.org/10.14245/kjs.2015.12.3.135

Kravitz, H. M., Janssen, I., Bromberger, J. T., Matthews, K. A., Hall, M. H., Ruppert, K., & Joffe, H. (2017). Sleep trajectories before and after the final menstrual period in the Study of Women's Health Across the Nation (SWAN). Current Sleep Medicine Reports, 3(3), 235-250. https://doi.org/10.1007/s40675-017-0084-1

Kravitz, H. M., Zhao, X., Bromberger, J. T., Gold, E. B., Hall, M. H., Matthews, K. A., & Sowers, M. R. (2008). Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep, 31(7), 979-990. https://doi.org/10.5665/sleep/31.7.979

Lei, J.-X., Yang, P.-F., Yang, A.-L., Gong, Y.-F., Shang, P., & Yuan, X.-C. (2021). Ergonomic consideration in pillow height determinants and evaluation. Healthcare, 9(10), 1333. https://doi.org/10.3390/healthcare9101333

Radwan, A., Ashton, N., Gates, T., Kilmer, A., & VanFleet, M. (2021). Effect of different pillow designs on promoting sleep comfort, quality, & spinal alignment: A systematic review. European Journal of Integrative Medicine, 42, 101269. https://doi.org/10.1016/j.eujim.2020.101269

Tian, S., Yao, C., Wang, Y., Cao, X., Sun, Y., Wang, L., & Fan, Y. (2025). The individualized optimal pillow height and neck support design for side sleepers. Medical and Biological Engineering and Computing, 63(2), 535-544. https://doi.org/10.1007/s11517-024-03204-x

Xu, Q., & Lang, C. P. (2014). Examining the relationship between subjective sleep disturbance and menopause: A systematic review and meta-analysis. Menopause, 21(12), 1301-1318. https://doi.org/10.1097/gme.0000000000000240